Thursday, February 27, 2014

Jean-Paul Sartre's 1944 classic "No Exit" described a group of (dead) people, forever locked in a room, trying to ascertain the nature of and reason for their punishment.

Fast forward 7 decades, and FoIB Jeff M alerts us to the story of 64 year old David Carpenter and his 62 year old wife, Sandra, locked in an even scarier scenario: the ObamaTax.

Seems that Mr C made a fateful and (as it turned out) costly mistake: he signed up for an ACA plan at the 404Care.gov site. This would prove to be a disaster, since it turned out that he also began to receive his well-earned VA benefits this year. Since there's not supposed to be any "double-dipping," he needed to cancel his ACA plan forthwith.

That's when he turned to his insurance agent, Stephanie Sheffield. As a Marketplace-certified agent, she was prepared to do battle on the Carpenter's behalf, but quickly learned that "[w]hen there is something that needs to be changed on the policy through the marketplace, no one seems to know how to fix it — not people at the marketplace nor their supervisors."

So in addition to being breeding grounds for ID theft, it turns out that Ms Shecantbeserious and her crew have no idea how to actually service their customers' changes. As a result, the Carpenters could end up owing Uncle Sam some major bucks:

"Carpenter’s dilemma is that at year’s end, he’ll have to pay back any insurance subsidy ... $8,160 for the whole year."

That's a lot of scratch for a couple who've been funemployed for the last 14 months.

Tuesday, February 25, 2014

Monday, February 24, 2014

T.R.A.G.I.C, the teacher group we blogged about in January formed to protest #Obamacare changes to the Georgia SHBP (State Health Benefit Plan) won a shallow victory. State and local government groups and school systems that use SHBP as their health plan received an email today, announcing retroactive changes in the health plan.

Readers may recall the uproar over the loss of copay plans and the announcement that BCBSGA was awarded the contract as the sole claims administrator for the health plan that covers 650,000 Georgia residents.

But Blue Cross was awarded the business in August of 2013 and there were no protests then.

During October SHBP particpants were given details on the new benefit packages. It was obvious there were no copay options. We had three choices, Bronze, Gold and Silver. All were high deductible HRA plans.

Where was TRAGIC then?

Crickets chirping

The state caved and agreed to overlay a doctor copay RETROACTIVELY to January 1, 2014. Yeah, that's going to be fun when Blue has to calculate refunds and then figure out if they restore dollars to an HRA or pay them to the policyholder.

Former WaPo Wonkblog health policy writer Sarah Kliff is a huge proponent of Obamacare and the expansion of health insurance. She's also been a recipient of excellent employer sponsored insurance benefits. Sarah has a problem. Here is what she tweeted:

2/20 at 11:27amSarah Kliff‏@sarahkliffReceived today an $820 medical bill that I was not expecting nor can I decipher because American health care.2/20 at 11:35amSarah Kliff‏@sarahkliff

I've never tried to negotiate down a medical bill before, but excited for this new personal and professional adventure!

Sarah, please allow me to help you out.First, you can't blame the American health care system as the reason for not being able to understand the bill. It's probably an issue with the coding - the little thing called ICD-9 soon to be ICD-10 that you wrote about just a week ago. If the coding was incorrect then the insurance company might have pended the claim until additional information was received.

Second, since the bill came from the provider my guess is that the $840 probably is retail charges. Having insurance provides you with a discount on the service. There are a few other things that could have caused you to receive the bill.

Could it be that the service isn't covered under your plan?

Could it be that you went to a non-network provider?

Could it be because your plan has a deductible that you haven't met yet?

You need to find an EOB that matches up to the bill you received. You should also review your SBC to make sure that the healthcare service was covered under the plan.

These are the questions a professional advisor would be asking you. From there we would take your bill and your EOB and work with your provider and insurance company to have the claim fixed. It is NOT an easy process - something I'm sure you are finding out.

Friday, February 21, 2014

If you want free money, where do you go? Not the lottery. Not lost and found. Jackson

Hewitt and H & R Block.

The store-front firm Jackson Hewitt is probably the most enthusiastic about the model. Its staffers will complete and even mail the Medicaid paperwork for clients who are eligible for expanded coverage. They are not licensed brokers so can’t sell insurance directly, but the firm has created a partnership with the commercial online insurance marketplace Getinsured which will help Jackson Hewitt customers buy coverage.

For no extra fee, Jackson Hewitt will figure your subsidy (and your penalty) when it prepares your taxes. And, if you want, it will send that information directly to Getinsured, where you can buy a policy.

Tax preparers participating in the largest wealth redistribution scheme in the history of the United States.

Jackson Hewitt isn’t alone: H&R BlockHRB+0.35% is partnering with the commercial online health exchange GoHealth to help people enroll through Block-branded online chat and phone support. In a pilot program, Block also will have insurance agents located in some Arizona tax offices.

Get your R.A.L. and #Obamacare at the same place. Why not food stamps and voter registration too?

I recently had the opportunity to give a team-building group exercise to my staff of Medical and Administrative professionals. The focus was on how to build a better team of individuals to better handle our increased patient load. In the beginning of the Seminar, I had everybody fill out an assessment as to how they felt we operated as a team. There were five categories to judge: Trust, Conflict, Commitment, Accountability and Results. The majority of the scores were low, demonstrating that this room full of people, who work with each other day in and day out, some for years, did not feel that they were a team.

Over three hours I discussed trust, conflict, communication, respect, personality types, the ego, how to disagree and how to come together as a group. We did numerous exercises to delve into these areas and discussed them as a team. At the end, when we are supposed to move into being a team, two members stated emphatically that they will never trust an administrator or any superior as long as they carried a license. So after three hours these people were no closer to begin working as a team than before.

Now I do need to make an observation: the Administrative Staff were more willing to work together for the common good than were the medical personnel. They were steadfastly islands unto their own.

So now I have twenty some people who instead of working together for the betterment of the organization, they will work for the betterment of themselves.

And that about sums up medicine.

The government has been attempting to make medicine a team event instead of an individual event. We use the term Provider instead of Doctor. We want to pay for a medical appointment based on how we judge the quality of the work, not for the work that was done.

For example, as an Administrator of an ASC (Ambulatory Surgery Center), I need to gather information on my GI doctors' Colonoscopy Documentation to report back to the government. When it is brought up to the powers that be that, gee, maybe they should ask the doctors for this information, we are told this is a great opportunity to build a connection with our physician’s office.

In surgeries, there is a Time Out, where someone other than the doctor calls for a pause to review the case, make sure they have the right person, make sure they know what body part they are operating on, if an arm or leg, which side, etc. The doctor has to wait for the Time Out to finish before s/he can begin.

Government and Administrators have tried to pigeon hole medical people into being a team, when in reality medical people are, for the most part, lone wolves. They have been trained to think this way, that if they make a mistake only they will be held responsible and they will go to jail. As such, all medical people have the mindset of “Trust but Verify.” They will not agree to anything they are told, until they see the rule, policy, guideline in black and white, and even then, if they don’t agree with what they are reading, it is disregarded.

So the battle will rage on between the Government that is trying to make medicine into their image and the medical personnel who will leave rather than comply, until medicine in America is fundamentally transformed.

Monday, February 17, 2014

So, one would presume that plenty of uninsured Hawaiians signed up for a shiny new health "care" plan, right?

Well, not so much:

"...so far, only 3,614 Hawaiians have filled out applications"

Remember, filling out an app is not the same as actually buying a plan, so we really have no way of knowing how many Aloha State citizens actually bought coverage (let alone how many have paid for it). But even with the benefit of the doubt, this means that each enrollee cost you and me almost $57 large. That's a lot of health care, no?

But that's still not the best part:

That 3,600 means that their best case scenario was to sign up 9,000 victims souls. Really? Given that about 1.4 million folks live in The Aloha State, and assuming 15% are uninsured, shouldn't their goal have been (at least) 180,000?

Seems clear to me the awful truth is dawning on more and more people that Obamacare is not worth its cost. Just as clearly, it looks like there is mounting disarray within the administration over what to do about it.

My take: sooner or later Dems must come to realize that their pedals aren’t really to the metal. The Obamacare insurance tactics are not capable of solving the underlying problem – which is high medical delivery costs. High insurance costs are symptoms of the problem – not the problem. That helps explain why tinkering with insurance has failed to solve the problem for more than 50 years.

What’s perhaps worse is that our politicians and so-called thought leaders have done such a miserable job of educating the public on the nature of the underlying problem. So public attention is focused on symptoms not the disease; the public is told a cure is at hand when it is not; and meanwhile the problem just continues to worsen.

Thursday, February 13, 2014

The director of Colorado’s health exchange has been placed on administrative leave after the state discovered she had been indicted for stealing from a non-profit,

National ReviewIn fairness, the indictment is not related to her current position as director of the CO exchange.But still . . .

The 12-page indictment alleges that, while serving as executive director of the federally funded Housing Montana, McClure, between 2008 and 2010, paid herself “significant sums” for consulting services, although she was already on the payroll as a full-time employee.

She also made payments to her family and used federal money for personal travel, to pay family bills and to buy consulting services, the indictment alleges.

She also is accused of charging homeowners for a $750 warranty that did not exist, converting a laptop for personal use, inflating the hours she was to be compensated and writing herself a $21,000 check to which she was not entitled.

Her pre-employment background check turned up nothing, but it seems she should have disclosed her past history.

The latest #ObamacareFail numbers are in and it isn't pretty. Just when you think it couldn't get worse, it did.

The White House has been dealt a stunning new blow on Obamacare sign-up numbers with reports showing that only about half of the people "enrolled" at healthcare exchanges in various states have actually paid their premiums.

With the March 31 deadline for enrollment just seven weeks away, the number of sign-ups in federal and state marketplaces has slowed down to an alarming figure since the sudden surge in the latter part of December and early January.

But the bigger problem for the Obama administration is that roughly 50 percent of consumers who had supposedly enrolled for President Barack Obama's healthcare reform have missed their payment deadline for Jan. 1, according to Investor's Business Daily's website Investors.com.

Wednesday, February 12, 2014

This just in from HHS Secretary Shecantbeserious (via email 3 days from the end of the initial ObamaTax Open Enrollment Period):

"From Saturday 2/15, at 3:00PM EST until Tuesday, 2/18 at 5:00AM EST, the Social Security Administration (SSA) will conduct annual systems maintenance activities ... During this period, verification of Social Security Numbers and other related data that is accessed via the Hub will be unavailable."

Oh, wonderful. But certainly one can at least access the main 404Care.gov site, right?

Um:

"Individuals attempting to complete the application process on HealthCare.gov during this period .... will not be able to immediately receive an eligibility determination/assessment from the Marketplace."

As regular readers know, agents that want to sell Partnership-compliant Long Term Care insurance (LTCi) plans must re-qualify every two years via a 4 hour "refresher" course. This helps to ensure that we're as up-to-date as possible on the latest LTCi news and policies.

Since my last one was in February of '12, I was due, and so spent this morning under the expert tutelage of Ray Copenheaver, CLTC, LTCP. As always, there was quite a bit to absorb, including news on deductibility of premiums (it just got harder) and on "gifting" to avoid Medicaid eligibility issues (you need to plan sooner).

But we also learned some other more positive tidbits, one of which I'll share here:

Two of the biggest objections folks have to even considering buying a plan is the premium and the (justifiable) fear of rate increases. A lot of the former is dependent on one's age and health, and what level of benefits one chooses. But there is precious little that one can do about the latter: if a carrier is going to increase rates, it's going to increase rates.

But there are a number of plan designs that allow one to bullet-proof one's plan against rate increases, and one of them is made possible by the PPA (no, not the PPACA): the Pension Protection Act that took effect 2 months prior (in January of 2010). One of the key provisions of the PPA is that it made it possible for carriers to offer a special kind of annuity: one that, in addition to tax deferred growth, offers tax-free long term care benefits.

Very cool.

Here's an example:

John and Mary own a non-qualified annuity (that is, it's not tied up in an IRA or other similar vehicle). Their original $50,000 deposit has now grown to a hefty $100,000 (hey. it could happen!). In ordinary circumstances, the $50,000 gain would be taxable. So if one of them needed long term care, they really have only $85,000 available (the original $50,000 plus whatever's left of the gain after taxes). Ouch.

But under PPA rules, they could trade in this annuity for one with an enhanced long term care benefit, and effectively double their long term care funds. In our scenario, the $100,000 "enhanced" annuity includes a $201,000 long term care "pool" from which either could draw to fund long term care, and these are paid out tax-free. Nice.

The downside, such as it is, is that if neither of them ever need long term care, the initial $100,000 (plus interest) is passed along to their beneficiary as a taxable instrument. Still, that's what would have happened had they kept the original plan, so no harm, no foul.

Since the plan is paid in a lump sum, there's no danger of any rate increase. and presuming that this was money that John and Mary weren't living on, it's not a direct out-of-pocket expense like a pay-as-you-go plan would be.

Notice it does not say "shall apply to months beginning after December 31, 2013, or whenever the President feels like it."

And yet, here we are (again).

So here's my question: if the ObamaTax is such a great idea, and if it is so vitally urgent that we insure as many Americans as possible as quickly as possible, then why in the Wide, Wide World of Sports is the President constantly putting it off?

The secret is out. #Obamacare is no longer a train wreck. It is a sinking ship.

Gary Lauer, chairman and CEO of Internet-based health insurance broker eHealth, said he no longer has confidence Obamacare can work in its current state. "We're stuck in this kind of abyss where it's all being left to government to do this. And just it's not going to work that way."

Consumers can come to eHealth for insurance, but Lauer's company is unable to process subsidies.

"If you're lower income right now, you can only go to a government-run exchange,"

That would be the same exchange that was designed by a Canadian firm with suspicious ties to FLOTUS, stumbled out of the starting gate, and still hasn't worked out a system to pay subsidies to carriers.

"It's much like saying, 'If you're low income, you can only ship a package through the Postal Service. If you're higher income, you can use FedEX or you can use UPS,'" he added. "We're working with the federal government to change that, and trying to get a few states to come around."

Ouch!

I wonder if the captain will go down with this ship or be on the lifeboat with the women and children.

The early results look very promising for self funding: if you are among the 80% of groups that were average or good health looking at a bad renewal under ACA, self funding rates are providing some relief.

Not all is smelling roses though; while worst case self funded is coming in better than ACA rates, they are not as low as current rates before the ACA renewal. While only 3% or so of groups with Agg have that worse year, employers are still having to get comfortable taking on risk and potential cost higher than a normal renewal.

They are also having to quickly learn the basics of self funding and be aware of some tricky fine print. Many of the self funded products offering to protect small groups from ACA have some traps of their own. They return only a portion of the savings, often as a credit only after renewal.

This means if they come in $60,000 lower then worst case, and what the group funded, they only get $40,000 back. That $40,000 credit also requires they renew with the carrier regardless if they feel the renewal offer is fair. There were carriers in the past that knew they could stick groups with a bad renewal because the cost to leave them was so exorbitant. For example, assume a 40 employee group came in $120,000 under max and thus was entitled to a $80,000 credit. If another carrier beat the current carrier by $60,000 on the renewal rates it would cost the employer $20,000 to change due to the lost credit. The in-force carrier obviously knows this, so they can pad the renewals for any case that had meaningful savings.

Still better than paying guaranteed higher ACA rates but some unlucky employers are going to lose a lot of savings if they aren't careful what self funded solution they go with....out of the pot and into the frying pan!

"... as many as 31 states do not conduct background checks on Obamacare navigators, who have access to enrollees’ names, Social Security numbers, financial records, and health information" [emphasis added]

And of course, this also doesn't include the hacktastic nature of the 404Care site.

Last month, we reported that Ms Shecantbeserious had unceremoniously dumped the Exchange website's Canadian contractor CGI for the winsome folks at Accenture. It was hoped that bringing in "new blood" would staunch the metaphorical hemoraging caused by CGI's apparent incompetence.

Well, Grandfathered policies. These are the plans that ostensibly fulfilled the empty promise that "if you like your current insurance, you can keep your current insurance" As we now know, this applied only to folks who made no substantive changes to their existing health insurance plans.

I'm fortunate to have a handful of clients who did not, in fact, make any such changes and whose plans are "grandfathered in."

Unfortunately, they won't be for long. Last week, one of my grandfathered clients received his 2014 renewal, along with a 28% premium increase. And there's nothing he can do about it because if he chooses to, for example, increase the deductible in order to rein in the premium, he loses grandfathered status.

So his only real choice is to pull the trigger on a new, ACA-compliant plan. In his case, this could actually save him substantial dollars versus his renewal. And because he's fortunate enough not to qualify for a subsidy, he can avoid the misbegotten Exchange. Of course he'll have higher out-of-pocket costs, and the knowledge that he could not, in fact, keep his current plan.

And he has to make his decision in the next few days if he wants a March 1st effective date.

Nice little policy you have there; be a shame if something were to happen to it....

UPDATE:
In the comments, Nate points out - quite correctly - that a viable
alternative to the challenge of grandfathered plans is to self-fund. Not
sure how that works? Never fear, Nate has the answer here.

Saturday, February 08, 2014

Just like at the liquor store, you can't use third party checks to buy health insurance either. No Schlitz Malt Liquor. No Obamacare.

Hundreds of people with HIV/AIDS in Louisiana trying to obtain coverage under President Barack Obama's healthcare reform are in danger of being thrown out of the insurance plan they selected in a dispute over federal subsidies and the interpretation of federal rules about preventing Obamacare fraud.

Some healthcare advocates see discrimination in the move, but Blue Cross and Blue Shield of Louisiana says it is not trying to keep people with HIV/AIDS from enrolling in one of its policies under the Affordable Care Act, also known as Obamacare.

The state's largest carrier is rejecting checks from a federal program designed to help these patients pay for AIDS drugs and insurance premiums, and has begun notifying customers that their enrollment in its Obamacare plans will be discontinued.

The carrier says it no longer will accept third-party payments, such as those under the 1990 Ryan White Act, which many people with HIV/AIDS use to pay their premiums.

But this is much more. It is the right hand not knowing what the other hand is doing.

In September, CMS informed insurers that Ryan White funds "may be used to cover the cost of private health insurance premiums, deductibles, and co-payments" for Obamacare plans.

In November, however, it warned "hospitals, other healthcare providers, and other commercial entities" that it has "significant concerns" about their supporting premium payments and helping Obamacare consumers pay deductibles and other costs, citing the risk of fraud.

Actually it is: just about every insurer and TPA in the country has been doing it for over a decade. Granted, there will always be an error here and there but nowhere close to the level of incompetence Covered California has achieved.

Anthem requires PD whether or not there are any children actually on the plan, and include a $5.20 charge for this cover regardless. Which seems seems as fair as charging single men and post-menopausal women for birth control convenience items.

Medical Mutual of Ohio says that those with adult only (no children) coverage can waive PD cover, buit those with children are required to enroll. They may, however, unenroll from this cover if they have valid comparable other dental insurance coverage.

Humana's PD coverage, like Anthem's, is "baked into the cake;" that is, it's included whether or not you want it (or need it). Same with United Healthcare/Golden Rule. There is no "opt out" provision, so one is charged for a benefit that one cannot ever use.

Here's the problem: under the train-wreck, groups can no longer use Health Reimbursement Arrangements (HRA's) to subsidize premiums. Jeff asked whether or not the employer could provide a "stipend" to each employee to help with the cost of insurance and, if so, what effect that would have on said employees' taxes.

I suspected that I knew the answer, but sought confirmation from my HRA gurus at FlexBank, who did not disappoint. Years ago, we used to fund some key employees' life insurance plans through something called an Executive Bonus. This was simply a fancy way to give the employee the money to pay for a personal life insurance plan, and it was (of course) included on their W-2's.

This seems to be the only legitimate arrangement open to the folks running Montgomery County; one suspects that the employees being unceremoniously dumped from their current health plans will be none too pleased to see the extra tax liability.

Talk about adding insult to injury (neither of which, apparently, are covered under the ObamaTax).

As to the first: why the heck not? Far be it from me, a lowly insurance agent, with a measly 30+ years of sales experience, to edumacate The Fair Kathleen on how to market insurance, but that is exactly the kind of product identification you want to encourage. After all, would-be Exchange victims customers are looking for, you guessed it, the term "Exchange."

As to the second, well, that's pretty dumb, too. Here's a dirty little secret, Kathy: as agents, we don't care who buys a plan from us - old, young, fat, skinny, healthy or sick - we want to, you guessed it again(!), sellinsurance. Last I looked, no carrier pays us commissions on plans we don't sell.

Perhaps the best part is that these are currently cast as "suggestions." Who wants to bet on their codification?

Did you buy an #Obamacare plan through the #exchange? Have you received your policy or ID

cards yet? Washington, we may have a problem.

Thousands of Americans who have asked the federal government to fix errors on their Obamacare applications aren’t likely to get solutions anytime soon, according to internal government data obtained by The Washington Post.

Some 22,000 Americans have filed appeals over errors made while applying for health coverage on HealthCare.gov, the website for Obamacare’s federal exchange, the newspaper reported. Those errors have included being pushed into the wrong program, receiving incorrect subsidies or insurance payments, and being denied coverage entirely.

But HealthCare.gov’s system won’t allow federal workers to go into enrollment records and make any changes to the applications. Washington Post reporter Amy Goldstein wrote. “The Obama administration has not made public the fact that the appeals system for the online marketplace is not working,” the story said, noting that the administration is more focused on other parts of HealthCare.gov that don’t work, such as the payment processing system.

Sounds like the Russians built the system.

Maybe they did . .

U.S. intelligence agencies last week urged the Obama administration to check its new healthcare network for malicious software after learning that developers linked to the Belarus government helped produce the website, raising fresh concerns that private data posted by millions of Americans will be compromised.

The intelligence agencies notified the Department of Health and Human Services, the agency in charge of the Healthcare.gov network, about their concerns last week. Specifically, officials warned that programmers in Belarus, a former Soviet republic closely allied with Russia, were suspected of inserting malicious code that could be used for cyber attacks, according to U.S. officials familiar with the concerns.

Russell Hutchinson hosts this week's round-up of risk-related bloggetry, with a soft voice and interesting context. Plus, he's come up with a great logo for the CoR, which I am shamelessly pilfering from him.

[If you have old golf clubs, you can keep your golf clubs....until April 2014.]

Until now, typically only the wealthy or financially responsible have been able to purchase new golf clubs without the assistance of their government.

This new law ensures that every American can now have "affordable" golf clubs of their own, because everyone is equally entitled to new golf clubs. And if you want to keep the golf clubs you already have, you can do that, until April 2014.

In order to make sure everyone participates and purchases their affordable golf clubs, the costs of owning golf clubs will increase 50% each year up to 400% by year 2018. This way, wealthy people will pay more for something that other people don't want or can't afford to maintain. People who can't afford or refuse to maintain their golf clubs will be fined. However, children under the age of 26 can use their parents’ golf clubs until they turn 27 at which time they must purchase their own golf clubs.

If you don't want or think you don't need golf clubs, you are still required to buy them. If you refuse to buy a set or make claims that you can't afford them, you will be fined $800 until you purchase a set or face imprisonment.

People living in farming areas, ghettos, inner cities, Wyoming, or areas with no access to golf courses are not exempt. Age, health, prior experience or no experience are not acceptable excuses for not buying, maintaining, and using your golf clubs.

A government review board that doesn't know the difference between a hook and a slice will decide everything. This includes when, where, how often and for what purposes you can use your golf clubs along with how many people can ride in your golf cart. The board will also determine if participants are too old or not healthy enough to be able to use their golf clubs.

They will also decide if your golf clubs have outlived their usefulness or if you must purchase specific accessories, like a range finder with slope adjustment or a newer and more expensive set of golf clubs.

Those that can afford memberships at expensive golf country clubs will be required to buy memberships. If you are already a member and you like your membership you can keep your membership. After April 2014, a different country club will be assigned for you to purchase a membership.Government officials are exempt from this new law as they and their families and some of their friends and a few of their friends friends can obtain golf clubs at taxpayers expense.

Monday, February 03, 2014

If you live near Albany, Georgia health insurance has never been cheap but for most it was

affordable before #Obamacare. The community rating requirements lumps citizens into 16 geographic regions for rating purposes. If you live in southwest Georgia your rates are some of the highest in the country.But only if you buy on the healthcare exchange, and only if you buy from Blue Cross of Georgia.

All the dynamics that drive up health costs have coalesced here in Southwest Georgia, pushing up premiums. Expensive chronic conditions such as obesity and cancer are common among the quarter million people in this region. One hospital system dominates the area, leaving little competition. Only one insurer is offering policies in the online marketplace, and many physicians are not participating, limiting consumer choice.

Kaiser Health NewsCommunity rating, which did not exist in Georgia prior to Obamacare, requires health insurance carriers to factor in the total health of the community along with the cost of health care in that area. Further complicating this Obamamess is the principle hospital in the area, Phoebe Putney.

Phoebe's dominance has also grown as it has purchased more physician practices. "Doctors you thought would never work for Phoebe are now Phoebe employees," said Sue Luckie, an insurance agent in nearby Leesburg.

Phoebe Putney and BCBSGA have never been friends, but it is much worse under Obamacare. If you bought a Blue Cross plan, on or off the exchange, and lived in the Albany area, there are no participating hospitals in their network for 100 miles.But when you search plans outside of the exchange you will find several plans that include Phoebe Putney and their premiums are much lower than Blue Cross.Sounds like time to change your insurance, but you need to do so before March 31, 2014. After that you won't be able to buy health insurance until the next open enrollment beginning November 15, 2014.That's something else you probably didn't know about Obamacare.